NOTE: The Department shall not accept for filing a Household Moving Services Certificate of Deposit Assignment which is not an original document issued by a Florida banking institution.

Household Moving Services Certificate of Deposit Assignment Form

(legal name of applicant for Intrastate Moving License), Assignor, does hereby assign, transfer, and set over unto the Florida Department of Agriculture and Consumer Services, Assignee, all right, title, and interest to and in Certificate of Deposit number entitled and issued by (name and address of depository) Depository, in the amount of $25,000.00 , excluding interest payable thereon. This assignment is made as security pursuant to Chapter 507, Florida Statutes, Household Moving Services, for (legal name and address of intrastate mover). Assignee takes this Assignment for the use and benefit of any consumer who is injured as a result of the Principal’s fraud, misrepresentation, breach of contract, misfeasance, malfeasance, financial failure, or any violation of Chapter 507, Florida Statutes,Household Moving Services. Liability for these injuries may be determined in an administrative proceeding of the Department or through a civil action in a court of competent jurisdiction, However, claims against this assigned certificate of deposit shall only be paid, in amounts not to exceed the determined liability for these injuries, by order of the Department in an administrative proceeding. This assignment includes any substitution or renewals to the Certificate of Deposit described, and shall remain in effect until Assignee notifies Depository in writing of the cancellation of this assignment.

Assignee is authorized to draw against the above Certificate of Deposit pursuant toChapter 507, Florida Statutes, Household Moving Services, and Depository is directed to pay up to the Principal Sum to Assignee upon demand. Partial draft is permitted. Any payments made pursuant to this assignment shall constitute acquittance of Depository. Depository shall not pay any portion of the Principal Sum to Assignor without prior written cancellation of this assignment from the Assignee. This Certificate of Deposit may not be encumbered in any way, and any attempted encumbrance is void.

Signature of Assignor / Date

Depository Acknowledgement of Assignment

The Assignor’s signature above compares correctly with our files. Principal Sum is $ ______, and the above assignment will be considered valid and honored until written cancellation is received from Assignee.

Depository Name:
Address:
City: / State: / Zip Code:
-
Telephone Number:
( / ) / -
Name of Authorized Depository Officer: / Title of Authorized Depository Officer:
Signature of Authorized Depository Officer / Date